Document Detail

Wandering coronary stenoses: adrenaline-induced coronary artery spasm in a patient resuscitated from cardiac arrest.
MedLine Citation:
PMID:  20517968     Owner:  NLM     Status:  MEDLINE    
A 68-year-old ex-smoker man with history of allergy, presented to the emergency department with progressive dyspnea one hour following self-medication with aspirin for troublesome headache. Examination revealed diffuse sibilant rhonchi over both lungs. Electrocardiogram showed signs of ischemia. In the intensive care unit, he received bronchodilators, nitroglycerin, and aspirin. Bronchospasm increased, and then the patient was shocked, and developed cardiac arrest. After resuscitation, he was kept on mechanical ventilation and adrenaline infusion. He was scheduled for coronary angiography. The left system demonstrated stenosis of the mid-segment of the left anterior descending artery (LAD), which was totally occluded distally, stenosis of the left circumflex (LCx) with a mild plaque in its marginal branch. The right system demonstrated stenosis of the mid-segment of the right coronary artery (RCA), with diffusely diseased posterior descending artery (PDA) and posterolateral left ventricular branch (PLLV). Successful direct stenting was performed to the RCA. Angiography demonstrated worsening of the distal stenosis in the PLLV and complete occlusion of the PDA. Balloon dilatation of the PLLV was adequate, but dilatation of the PDA failed. Repeat angiography of the left system revealed an occluded LCx with critical stenosis of its marginal branch; nevertheless, the LAD was as before. Balloon dilatation of the distal LAD was attempted without improvement, yet, angiography therein, demonstrated "migration" of the stenoses in the LCx. The procedure was halted, adrenaline infusion discontinued, and an intra-aortic balloon pump inserted. The patient was discharged one day later. Follow-up angiography 6 months later demonstrated mild atherosclerotic coronary irregularities.
Salvatore Battaglia; Wail Nammas
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions     Volume:  75     ISSN:  1522-726X     ISO Abbreviation:  Catheter Cardiovasc Interv     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-06-02     Completed Date:  2010-09-07     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100884139     Medline TA:  Catheter Cardiovasc Interv     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1056-9     Citation Subset:  IM    
Department of Cardiology, Hôpital Européen Georges Pompidou, Paris, France.
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MeSH Terms
Adrenergic Agonists / administration & dosage,  adverse effects*
Angioplasty, Balloon / instrumentation
Coronary Angiography
Coronary Stenosis / chemically induced*,  radiography,  therapy
Coronary Vasospasm / chemically induced*,  radiography,  therapy
Epinephrine / administration & dosage,  adverse effects*
Heart Arrest / therapy*
Infusions, Intravenous
Intensive Care
Intra-Aortic Balloon Pumping
Respiration, Artificial
Treatment Outcome
Reg. No./Substance:
0/Adrenergic Agonists; 51-43-4/Epinephrine
Comment In:
Catheter Cardiovasc Interv. 2010 Jun 1;75(7):1060-1   [PMID:  20517969 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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